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Utilization of medical care among children with Down's syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Övrig pediatrisk forskning/Nordvall)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Övrig pediatrisk forskning/Nordvall)
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2002 (English)In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 46, no 4, 310-317 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The present authors have previously found an increased mortality rate in children with Down's syndrome (DS) and a congenital heart defect (CHD). The aim of the present study was to investigate the utilization of medical care in relation to congenital malformations in DS.

METHOD:

Retrospectively, 211 children with DS born between 1973 and 1980 in the northern part of Sweden were followed up for at least 17 years (1973-1997). The duration of neonatal care was compared with that of children with DS born between 1995 and 1998 in the same region.

RESULTS:

Neonatal care was reduced over time. Almost 50% of the children had CHD, and before 10 years of age, these subjects were admitted for inpatient care twice as often as children with DS who did not have malformations, and had more than 12 times as many inpatient days per month. The existence of a gastrointestinal or other malformation increased inpatient days per month four and two times, respectively, compared to healthy children with DS. During the first 10 years of life, children with DS and a CHD accounted for 71% of all inpatient days caused by infections. No gender differences were observed.

CONCLUSIONS:

At a group level, the presence of a CHD was the most important congenital abnormality in determining utilization of medical care and the burden of infections in the population of children with DS.

Place, publisher, year, edition, pages
2002. Vol. 46, no 4, 310-317 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90073DOI: 10.1046/j.1365-2788.2002.00392.xISI: 12000582OAI: oai:DiVA.org:uu-90073DiVA: diva2:162231
Available from: 2002-12-17 Created: 2002-12-17 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Children with Down syndrome -: an epidemiological study with special focus on congenital heart defects
Open this publication in new window or tab >>Children with Down syndrome -: an epidemiological study with special focus on congenital heart defects
2002 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To assess the impact of congenital malformations in Down syndrome (DS) on morbidity, mortality and outcome at birth, information on all children with DS born in the northern part of Sweden in 1973-80 (n=211) and 1995-98 (n=88) was collected. Most common were congenital heart defects (CHD), dominated by atrioventricular septal defects (AVSD). Up to age 10 years, morbidity and mortality were more than 10 times higher in DS children with CHD than in healthy DS children. The DS children seemed more vulnerable at birth than Swedish children in general: they had increased frequencies of Cesarean sections, premature birth, asphyxia, and low birthweight, and higher proportions of children small for gestational age, regardless of the presence of CHD. Infant mortality decreased from 14.2% to 2.3% between the two periods.

All children with AVSD with and without DS born in Sweden 1973-1997 (n=801) were followed up retrospectively to 2001. Children with isolated AVSD without complex additional CHDs were studied more closely (n=502). A reduction in age at operation and postoperative mortality (from 28 to 1%) was observed. No significant difference in 5-year postoperative mortality between genders or between DS and non-DS children was found. The 5-year postoperative mortality in DS decreased from 35% in 1973-77 to about 10% in 1993-97.

CHD had a major influence on morbidity, infectionrate and mortality in DS, but not on DS birth variables. The formerly high mortality in CHD is now reduced. In isolated AVSD measures seem equally successful in DS and non-DS children. Mortality is still 3 times higher in DS children with isolated AVSD than in healthy DS children.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2002. 62 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1218
Keyword
Pediatrics, Down syndrome, congenital malformations, mortality, morbidity, neonatal data, congenital heart defect, atrioventricular septal defect, operation, gender, Pediatrik
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-3142 (URN)91-554-5496-8 (ISBN)
Public defence
2003-01-31, Rudbeckssalen, Rudbecks Laboratoriet, Uppsala, 09:15
Opponent
Available from: 2002-12-17 Created: 2002-12-17Bibliographically approved

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